Posts Tagged ‘Science of weight control’

Debra’s Gone Defunct (not entirely — I’m not dead)

In Weight-Loss Maintenance on October 3, 2011 at 10:10 am

Welcome, newcomers and old friends, to Debra’s Just Maintaining!  For roughly a year, starting September 29, 2010, this blog set about exploring the cultural mythology and science surrounding weight-loss maintenance, especially after “radical” loss (more than 10% of highest body weight).  As blog owner, I found myself moderating a discussion involving mostly weight-loss maintainers and size acceptance proponents, two seemingly disparate groups who ended up having more in common than any of us might have expected.   It turns out we are all betrayed by the myth that radical weight loss is some hard-won victory, to be followed (of course!) by maintenance, a less challenging, zippy “lifestyle” composed of tips and tricks.  It’s much more complicated than that. 

This blog is not a “big” blog, but big enough, and certainly has much heart.  Over the year it received just over 60,000 “views” of its various posts.  Many were repeat visits from people I came to regard as friends, dear friends.  We shared a sort of cathartic grief process as we stripped apart the mythology, and discussed from a lay vantage point some of the science surrounding weight-loss maintenance.   In addition to the maintainers and size acceptance advocates, we also entertained a scientist visitor from time to time, and a couple of trolls.

The blog is now mostly defunct because I have gone on to other time-consuming pursuits, and I also need time to be a good Mom, and to continue my weight-loss maintenance, an endeavor that I regard as a third- to half-time unpaid job.  To be competent at these things, something had to give. 

Since the blog is mostly defunct, it’s likely that you arrived here because someone sent you here or you conducted a search for “Weight-Loss Maintenance” or some topic discussed here.  A lot of people find this blog with searches to the effect: “Is obesity killing our children?”  If that is you, you are looking for this post.  Other people are apparently interested in a maintainer’s take on intuitive eating.  That would be here and here.  And a lot of people want to know what I think about journalist and anti-carb pundit Gary Taubes.  Those posts are here and here

If someone sent you here, it may be because you just lost a lot of weight and said something silly like, “If I can do it anyone can!”  Then that person wants you to start with the post subtitled Skiing as Useful Metaphor.

Other reasons someone may have sent you here: 

  •  You said something insensitive or rude about fat people being “in denial.”
  • You said something insensitive or dismissive of someone who works hard to maintain a particular weight – along the lines of “but certainly the rewards outweigh any effort you expend.” 
  • You said something definitively naïve, such as, “science has proven people are fat because of modern breakfast cereals.”  
  • You announced that you are embarking on a weight-loss process/diet (what number?), and a friend wants you to have a realistic idea of what lies ahead, more so than what some women’s magazine or morning news show may be touting today as a “breakthrough.”
  • You are struggling with weight-loss maintenance.  Perhaps your weight is sliding.  You need affirmation from a kindred spirit who knows how challenging this is, and doesn’t sugar coat it or pop off with “inspirational” platitudes. Read the rest of this entry »

What Katarina Borer Found: Good News for Maintainers?

In Weight-Loss Maintenance on July 8, 2011 at 12:52 pm

Before I say another word, my conscience tells me to add a BIG trigger caution here.  If you are a size acceptance proponent and are feeling the least bit susceptible to the call of the weight-loss diet fairy, skip today’s post.  If you’re feeling brave, however, I’d love your response as well as that of my maintainer friends.

In my last post I explained Katarina Borer’s methodology for comparing the effects of food intake and exercise on appetite and on certain endocrine secretions.  Dr. Barry Braun describes it as “a multicondition crossover design to cleverly disentangle the relationships between energy imbalance, exercise, energy intake, putatative energy-regulating hormones and perceived appetite.”  Yup.   That’s what it was.  Now, let’s see whether I can explain in plain English what happened and what was correlated and what was not.

In her first study, Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track changes in energy Availability, Dr. Borer found:  

  1. Human appetite is influenced by the passage of food through the mouth and gastrointestinal tract.  When food went through the mouth, it triggered GIP, a gut peptide that is activated and serves as a marker for GI activity but seemingly has no affecting qualities of its own.  This peptide rose and fell in concert with participants’ reported appetites. 
  2. Participants’ appetites responded to the size of meals that came in through the mouth, but were insensitive to calorie replacements (or saline placebos) that came through an IV.  Moreover, exercise did not increase appetite, but marginally suppressed it.  This led her to state that “between-meal increases in circulating nutrient load and exercise energy expenditure are not under homeostatic feedback control.”
  3. Ghrelin, leptin and insulin respond in slightly different ways to changes in energy availability, but had no influence on participants’ appetites.  Whoa.  Interesting, yes?  Dr. Borer thought so too.

The graph array that interested me most, as a maintainer, however, was Figure 2 (in the second study it was reposted as Figure 4).  I was surprised, in fact, that it was not included as a “finding” in the Discussion section.

It looks fuzzy in my preview, but I was able to click on it to get a blown-up view that was very clear.  Column 4 describes the trial day Read the rest of this entry »

More Thoughts on Endocrine

In Weight-Loss Maintenance on June 20, 2011 at 9:53 am

It’s useless to try to persuade me to be uninterested in endocrine.  If your interests lie elsewhere, I forgive you for skipping my entries on the topic.

First the news:  I heard from Katarina Borer, author of Exercise Endocrinology

As a lay person, it’s hard to know what qualifies as a respected source on a particular topic.  What I know is that in terms of textbooks, it’s the first that pops up when you do searches on Google, Yahoo or Bing using the terms “exercise endocrine.”  It gets Google’s top honors, in that it appears in the number one position, above articles from clearly “popular” sources, such as  Moreover, two other articles from Katarina Borer appear in top ten slots.  That’s my confession.   I have accepted this woman’s qualifications on the basis of her Google Quotient.  She, of course, rose even higher in my esteem when she contacted me by email, and attached three articles for my review (two in which she was lead author, one a commentary on one of the other pieces).  She attained nearly saint status by paying me a compliment, “I found your postings interesting and remarkably well-informed for a person who is not actively engaged in research.”

There.  Confessions dispensed.  I will, sometime soon, review those articles, but they will require time to digest.  I have read each one’s first two paragraphs, and it is apparent to me that I will need to read these articles when my intellectual cylinders are all firing properly and I am under the influence of a precise dose of caffeine.  (Too little and I don’t make important, rapid mental connections; too much and I start cleaning my house instead.)

Several things emerged in the comments on my last post that gave me “Eureka” twinges:  

  1. That other people experience “eat impulses” and at least one commenter feels relieved to have language to describe them.   Our vocabulary, clearly, is constrained by having only two words to describe the sensations that precede eating:  hunger and appetite.  With dozens of hormones, peptides, proteins and the like, reacting in hundreds or thousands of combinations with our individual gene profiles and contributing to our metabolic processes, it seems a bit silly to me that we reduce the entire process to two, singular tense, words.  Moreover, the limits imposed by these two words have created a perfect Petri dish for fomenting the social discord we size acceptance proponents know as weight bias and the oppressors are happy to use in a “war on obesity.”  To wit:  “If you don’t eat when you’re hungry, obviously you’re simply responding to appetite, you out-of-control schmuck, and we, society, will judge you harshly for that if it results in a larger body than we find pleasing.  Hmmmmph!  (We’ll leave you alone or even venerate you if you can eat sans hunger and remain trim.)” Read the rest of this entry »

An Open Letter to Weight-Management Scientists

In Weight-Loss Maintenance on June 15, 2011 at 1:22 pm

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine.  Read the rest of this entry »

Hey, Everybody: Let’s Help Diane!

In Weight-Loss Maintenance on May 17, 2011 at 12:12 pm

First of all, thanks again to Dr. Sharma for hooking us in to the private world of obesity research where the erudite players who affect our lives talk about us.  Specifically, today he linked us to the Canadian Obesity Network Presentation Portal for the Second Annual Obesity Summit held in Montreal April 28 – May 1 of this year. 

Let’s give these CON-RCO people kudos for facility and detail.  If you click on the presentations, you receive a split screen with the speaker, in focus and centered, on the left and his or her Power Point Notes on the right.  How inviting!  Whatever trouble that took, please know it is appreciated!  Hooray.  

I scrolled through the selections to find some interesting conversation fodder, and my heels came to a screeching halt on page two, where speakers were talking about weight discrimination and bias.  I first was drawn in by this title:  So I am Biased, Now What Do I Do?  Michael Vallis, the co-director of the Capital Health Behaviour Change Institute and Associate Professor at Dalhousie University spoke well, and we may want to talk about him another day, especially how he seems to ice skate between talking about solving bias/discrimination and solving obesity – interesting and discomfiting.   He also talks about Motivational Interviewing, which we have talked about some in these pages’ comments.  As I listened to him I wore Hopefulandfree’s filter:  is this just sophisticated manipulation?  I don’t think he intends it to be, but I can see how it goes there.

But I digress.  TODAY, I want to talk about Diane Finegood’s talk, Weight bias and discrimination through a complex-systems lens.   About 22 minutes into the 26-minute speech, she presents us with a question, and with an earnestness that I think calls for reply.  I think we might be able to help her.

Diane Finegood is a professor at Simon Fraser University and Executive Director of the CAPTURE Project (CAnadian Platform To increase Usage of Real-world Evidence).  She’s also a radical weight-loss maintainer.   

Her presentation, in simple terms:  It ain’t easy to change a paradigm on a complex system, such as obesity bias as it relates to health care.  You’ll want to watch the whole thing, as she starts with a complex map of the issue and then reduces the problem downward several times to arrive at five steps.   The most important:  shifting the stinking paradigm.  This has to be done by attacking lower level issues – structural elements, goals, etc.  But at the very top is that paradigm, or root assumption.  She makes a stab at one-sentence statement to express what that paradigm should become, but she’s clearly uncomfortable.  Even her Powerpoint notes have a question mark.  Her attempt at a statement:

? “Obese people are no different because of their size.” Read the rest of this entry »

Why I Will Continue to Read Arya Sharma’s Blog

In Weight-Loss Maintenance on May 11, 2011 at 12:47 pm

In yesterday’s post, I was pretty hard on Dr. Sharma.  I also contacted him by email and let him know that he had provoked a munity among a chunk of the HAES community who read his blog and respect his opinion, if not always in full agreement.  He responded thoughtfully and at length. 

My thoughts: 

Blog’s are written quickly.  Dr. Sharma says he is often asked whether his is ghost written (as I did).  It is not.

Now, regarding his emails, he didn’t apologize for his posts of May 9th or 10th.  Following is the closest thing he offered to an apology (note that you are “they”):

Their anger, trauma, suffering, frustration, disillusionment with the medical ‘establishment’ is all very real and understandable – in short – I can fully see ‘where they are coming from’.

So while some of them may now be hurt, frustrated and disillusioned by my post (which, really was not a personal attack, but rather a reflection of the kind of ‘uncritical’ thinking and arguments that I see reflected in some of the comments left on my site), this is not really the audience that I write for or even see in my practice. I am not out to talk anyone out of HAES or Fat Acceptance or anything else that they are happy and comfortable with.

I primarily write for my colleagues, to try and help them keep up with the latest research in this fast moving field, and perhaps over time change their understanding of obesity and their attitudes to people with obesity, who may wander into their practice.

Now, while we aren’t his central audience, he isn’t completely unappreciative of us.   He says that people who come to his blog and (respectfully) disagree with him “represent an interesting and important view point, which although by some standards extreme, certainly serves as a reality check to me and other readers – a reminder that there are other opinions out there.”

So, what set him off?  If we aren’t his central audience, I don’t think it was us.  (Even though some of us have been less than entirely respectful.)  I think, and this is only speculation, that we were hit by the shrapnel of a bomb aimed mostly at Linda Bacon.  Admittedly, in my first email to him I singled her out:  “Some HAES commenters are prickly about you, including Linda Bacon herself, but most have appreciated that you’ve kept an open mind despite unknowable pressures from others in your field.”  So, while the following paragraph may be revealing, my words may have provoked it.  (Attempt to read it aloud at your own peril.) Read the rest of this entry »


In Weight-Loss Maintenance on May 2, 2011 at 11:44 am

Jimmy Buffet in Concert in Kansas City, April 30, 2011

I really wanted to share with you, my blog friends, my fun weekend, but was at a loss as to how to tie it to the core subject of this site.  Then, once again, Dr. Sharma came to my rescue (that later).

Not only was my weekend fun, but it was steeped in irony.  I had floor tickets for the Jimmy Buffet concert in Kansas City.  Here I am with my husband. 

Fashion Faux Pas: no parrot hats.

 Here are our dear old friends, who came from Columbia, Missouri, to join us.

Randy and Nanci at Jimmy Buffet

The event was ironic in that NO ONE who could afford floor tickets could have possibly been the drunken, deadbeat, pothead losers that we were all celebrating ourselves to be.  It was all a stinking ruse.  We were, in fact, middle aged (or upper middle aged) mostly professional types, many sporting Hawaiian shirts.  Here are some pictures from the crowd. Read the rest of this entry »

Word Play: Addiction v. Compulsion

In Weight-Loss Maintenance on April 8, 2011 at 12:45 pm

I thought my most recent post would be a “quickie.”  Here’s something interesting in Science Daily on food addiction linking ghrelin to excessive sugar consumption.  I expected a few responses.  “That’s nice, and resonates with me because blah blah.”  Or, “Fine, but that’s not my issue.” 

We all go home. 

What I learned instead is that the word “addiction” is not even recognized in certain professional circles (those who treat substance abuse, e.g.) and that many find the word “compulsion” less judgmental and more useful in treating people who engage in excessive behaviors. 

For some reason, in our discussion, we were compelled to raise the topic of “sex addiction,” and I, for grins, visited this site analyzing the Tiger Woods debacle:  Sex Addiction:  What Tiger Woods’ Story Forces us to Confront.  

Here are the first two paragraphs:

From Tiger Woods to Lifetime movies, there has been no small amount of conjecture about the slippery concept known as ‘sex addiction.”  But does such a condition really exist?  Finding out requires sweeping aside the presumption, dismissiveness, and shame that clouds the subject.

The phenomenon didn’t have a name until 1983 when psychologist Patrick Carnes published the influential book, Out of the Shadows: Understanding Sexual Addiction. Prior to that, the behavior was described as “hyper-sexual arousal.” In short, the term “sex addiction” is used to describe a pattern of frequent, progressive, and often secret sexual behavior, even when the behavior jeopardizes a person’s time, employment, financial stability, relationships, and reputation. While often conflated with adultery, sex addiction does not necessarily mean cheating—or even intercourse. Rather, it can manifest as a dependency on pornography, masturbation, phone or Internet sex, and other related behavior.

Now, that opening reads sensibly enough to these eyes, trained by our “developed” culture to accept certain logical leaps.  However, it was easy to see that we, indeed, may have a problem (practical and/or semantic) when we “translate” it to a comparable analysis of the less understood/accepted concept of “food addiction.” Read the rest of this entry »

Bingeing. Mini-bingeing. Is it Addiction?

In Weight-Loss Maintenance on April 6, 2011 at 11:55 am

I appreciate science that debunks the notion that we eat and gain weight because we are emotionally out of control and we just need to buck up and make better decisions:  Push away from the table.  Drop the fork.  Hit the gym.  Ignore the fridge.  Science tells us it’s not that simple; food may be a complicated “addiction.”

Many of my blog world friends are talking about food addiction:  Here’s the most recent post on that topic from Beth, the Weight Maven, who has many well thought-out posts on the concept.  Barbara at RTR, is also using the “A” word.   

I struggle with the notion of calling eating that leads to fatness “addiction.”  It is likely inaccurate for many people.  Moreover, it doesn’t prevent fatphobic lay people from pigeon-holing and demonizing fat people.  (Do NOT go to My Fat Spouse and run a search on “food addiction”; just trust that you will be disappointed.)  On the other hand, the word seems to help doctors get beyond the notion that their patients merely need to “get serious” and be “compliant.”

In Science Daily, there’s a nice summary of a study out of Sweden, that links a gene variant, that affects the signalling system for the neuropeptide ghrelin, to cravings for sugar and alcohol (and, by leap, then, to binge eating and alcohol addiction).  Here’s the actual study.      

In simpler words, the study links ghrelin to sugar-seeking (and alcohol-seeking) behaviors, by way of a genetic variant.  Sugar seeking, sadly, is not my issue, darn it (and this blog is about me, after all).  I have said before that I am painfully aware that my internal chemistry has changed since my radical weight loss, which makes maintenance of that loss a hell of a lot harder than popular celebrities like Jillian Michaels would have us believe.   And, given past research that links voluntary radical weight-loss to a 24% average increase in Ghrelin throughout the day, I have blamed Ghrelin.  I may be wrong.    Read the rest of this entry »

So, Will Obesity Kill our Children at a Younger Age that Us?

In Weight-Loss Maintenance on March 5, 2011 at 10:06 am

Today I’m going to blow more than 1,000 words examining a single sentence in the Linda Bacon/ Lucy Aphramor treatise, Weight Science:  Evaluating the Evidence for a Paradigm Shift.  This sentence appears in the final paragraph of the subsection entitled, “Assumption:  Adiposity poses significant morbidity risk.”   Before I present the sentence, some pre-amble (digression).

In this subsection Bacon and Aphramor cast doubt on the assumption that our fat is killing us.  They separate “causation” from “association,” and also talk about and footnote (to my satisfaction) the “obesity paradox,” a convincing pattern that has emerged in epidemiology that links “overweight” and “obesity” to improved outcomes and longer survival periods in the case of many critical medical battles. 

Why do we call this an obesity paradox?  Why does it surprise us?  I’d call in the “obesity survival rate no brainer.”  Isn’t it fully logical that a person could benefit from some added fuel if he or she is contending with a serious chronic disease, recovery from a violent medical event (such as a heart attack) or a radical surgery that involves a rehabilitation period in which appetite is suppressed?  If there is a medically induced period where the body must waste some of its stores, who’s gonna fare better:  the presumably unhealthy “obese” person or the “healthy weight” person with the 19 BMI?  I know where I’m placing my bets in Vegas. 

Nevertheless, despite the recent acknowledgement of this “obesity paradox,” and despite the US National Institutes of Health telling us we are living longer and more robustly now than in any preceding generation, we keep hearing that our fat is killing us.  Moreover, there is a recent insidious catch phrase that has emerged:  “this is the first generation of children that may have a shorter life expectancy than their parents.”  Huh?  As Bacon and Aphramor point out, this statement continues to appear in popular mainstream media and with the imprimatur of a former Surgeon General.  But, is it true?  It’s alarming to think our children will die younger than us! Read the rest of this entry »